STRESS : MANAGEMENT AND CURRENT TRENDS · introduction the fight flight response how does stress affect us? simple stress coping strategies the relaxation response stress coping strategies
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STRESS : MANAGEMENT AND
CURRENT TRENDS
BY : Dr. Niharika Singh
MBBS, MD Psychiatry
Assistant Professor, Department of Psychiatry,
WORLD COLLEGE OF MEDICAL SCIENCES AND RESEARCH AND HOSPITAL
INTRODUCTION
THE FIGHT FLIGHT RESPONSE
HOW DOES STRESS AFFECT US?
SIMPLE STRESS COPING STRATEGIES
THE RELAXATION RESPONSE
STRESS COPING STRATEGIES THAT CAN BE
INITIATED/SELF-TAUGHT
OVERVIEW OF PSYCHIATRIC STRESS
MANAGEMENT METHODS
CURRENT TRENDS IN STRESS MANAGEMENT
CURRENT TRENDS IN STRESS MANAGEMENT FOR
MEDICAL STUDENTS
CONCLUSION
OVERVIEW
INTRODUCTION
RECOGNISING STRESS
INTRODUCTION (contd.)
That „bridge collapse‟ in a human being can take many forms:
Maladaptive responses to stress:
POST TRAUMATIC STRESS DISORDER
CARDIOVASCULAR DISEASE
THE METABOLIC SYNDROME: ESSENTIAL HYPERTENSION,
TYPE 2 DIABETES, HYPERLIPIDEMIA, OBESITY
DEPRESSION
ANXIETY DISORDERS
It is not the stressor that causes stress but the individual‟s
perception and emotional reaction to it.
Principles and Practice of Stress Management, Third Edition edited by Paul M. Lehrer,
Robert L. Woolfolk, Wesley E. Sime, 2007, Guilford Press
FIGHT OR FLIGHT RESPONSE
During dangerous situations, through the release of
hormones such as adrenaline, cortisol and norepinephrine,
heart pounding, fast breathing sensation as well as a boost of
energy, enables us to focus our attention so we can quickly
respond to the situation.
In today‟s world, the „fight or flight‟ mode can still help us
survive dangerous situations, for example, reacting swiftly
to a person running in front of our car by slamming on the
brakes.
Stress Management and Prevention: Applications to Daily Life
By Jeffrey Kottler, David Chen. Thompson Learning Inc. 2008
FIGHT OR FLIGHT RESPONSE (contd.)
The challenge is when our body goes into a state of stress in
inappropriate situations.
If we are kept in a state of stress for long periods, it can be
detrimental to our health. The results of having elevated
cortisol levels can be an increase in sugar and blood
pressure levels, and a decrease in libido.
Stress Management and Prevention: Applications to Daily
Life By Jeffrey Kottler, David Chen. Thompson Learning Inc. 2008
HOW DOES STRESS AFFECT US?
www.stress.org.uk
HOW DOES STRESS AFFECT US?(contd.)
www.stress.org.uk
HOW DOES STRESS AFFECT US?(contd.)
www.stress.org.uk
HOW DOES STRESS AFFECT US?(contd.)
www.stress.org.uk
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New Harbinger
Publications. Oakland, CA.
Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by Changing the Way You Think. Guilford Publications.
New York, NY.
SIMPLE STRESS COPING
STRATEGIES
SIMPLE STRESS-COPING STRATEGIES
Get enough sleep
Sleep is essential for the body to function properly. Adults
can adopt helpful sleep-enhancing routines.
www.stress.org.uk
SIMPLE STRESS-COPING STRATEGIES
(contd.)
Listen to music
Music can be used in many situations to help reduce
stress and create a calming atmosphere:
Use classical music to concentrate as it is peaceful, harmonious
and doesn‟t have lyrics.
Music can also be a reminder to take breaks.
When using music to help you relax before sleep, choose
soothing music with monotonous repetition, such as sounds of
nature or ambient music
www.stress.org.uk
SIMPLE STRESS-COPING STRATEGIES
(contd.)
Manage your time optimally
Stress often results from difficulty in coping with day-to-
day problems and conflicting responsibilities.
A useful strategy for dealing with a sense of being
overwhelmed by all the things that need attention is
prioritizing and diarizing.
Create time buffers to deal with unexpected
emergencies – this is a great way to prepare and avoid
excess stress.
www.stress.org.uk
SIMPLE STRESS-COPING STRATEGIES
(contd.)
If you‟re ill, rest
Learn to say „no‟
Where a „no‟ is the appropriate response, say it without guilt.
„No‟ also doesn‟t have to be a decline, it can also be a
„negotiation opportunity‟, e.g. “ I can‟t do that now, but I can
do it in next week”.
Work off stress with physical activity
www.stress.org.uk
SIMPLE STRESS-COPING STRATEGIES
(contd.)
Hobbies
Avoid nicotine, alcohol, caffeine and refined sugar
products
Take Breaks
Working in 90-minute cycles with breaks in-between can
help optimize productivity and can help shorten the time it
takes to complete a task.
www.stress.org.uk
SIMPLE STRESS-COPING STRATEGIES
(contd.)
Talk to someone
We‟ve all heard of the saying “a problem shared is a
problem halved”
If you are troubled by something, don‟t suppress it.
Instead:
Speak to a friend or family member
If you don‟t feel comfortable speaking to a loved one or if
feel you stress is putting you at risk, visit us.
www.stress.org.uk
THE RELAXATION RESPONSE
In the late 1960‟s, at Harvard Medical School, Herbert
Benson, M.D. found a counterbalancing mechanism to the
stress response.
Stimulating an area of the hypothalamus can cause the
stress response, activating other areas of the brain
results in its reduction.
This opposite state - THE RELAXATION RESPONSE.
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
THE RELAXATION RESPONSE (contd.)
Relaxation response - physical state of deep rest that
changes the physical and emotional responses to stress.
When eliciting the relaxation response:
Metabolism decreases
Heart beats slower and muscles relax
Breathing becomes slower
Blood pressure decreases
Calmer state of being achieved
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
THE RELAXATION RESPONSE (contd.)
Elicitation of the relaxation response is easy.
There are two essential steps:
1. Repetition of a word, sound, phrase, prayer, or muscular
activity.
2. Passive disregard of everyday thoughts that inevitably
come to mind and the return to the repetition.
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
THE RELAXATION RESPONSE (contd.)
Regular elicitation of the relaxation response has been
scientifically proven to be an effective treatment for
stress-related disorders.
Other techniques for evoking the relaxation response are:
Mindfulness Meditation
Progressive Muscle Relaxation
Deep Breathing
Imagery
Self-Massage
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
STRESS COPING STRATEGIES THAT
CAN BE INITIATED/SELF-TAUGHT
MINDFULNESS
Mindfulness is the quality of being fully engaged in the
present moment, without over-thinking or analyzing the
experience.
It switches the focus on what is happening right now, rather
than worrying about the future or dwelling on the past.
It takes effort to maintain concentration and to bring it back
to the present moment when mind wanders or drifts off.
With regular practice:
Strengthens the areas of the brain associated with joy and
relaxation
Provides a potentially powerful antidote to the common causes of
daily stress.
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
MINDFULNESS (contd.)
Mindfulness meditation techniques:
Body Scan - Focusing attention on various parts of the
body. Like progressive muscle relaxation, start with feet
and work way up.
Walking Meditation - Mindfulness involving focus on
the physicality of each step; the sensation of feet
touching the ground; the rhythm of breath while moving.
Mindful Eating – If one reaches for food when stressed,
or gulps meals down in a rush, try eating mindfully.
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
MINDFULNESS (contd.)
Relax in a Hurry
Mini-relaxation exercises help reduce anxiety and tension
immediately. They can be done anywhere, any time, and
no one needs to know!
The basic method for doing is quite simple:
Put your hand just below your navel. Take a deep breath,
bringing the air in through your nose and through your
mouth. You should feel your stomach rising about an inch
as you breathe in, and falling about an inch as you breathe
out.
This is diaphragmatic breathing.
Principles and Practice of Stress Management, Third Edition 2008
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime Chapter 4 Progressive Relaxation by Guigan,
Lehrer
PROGRESSIVE MUSCLE RELAXATION
Effective and widely used strategy for stress relief.
Technique for reducing overall body tension.
It involves a two-step process in which you tense and
relax different muscles in the body.
With regular practice, helps recognize what tension as
well as complete relaxation feels like in different parts of
the body.
This awareness helps spot and counteract the first signs
of the muscular tension that accompanies stress.
Principles and Practice of Stress Management, Third Edition 2007
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime Chapter 4 Progressive Relaxation by Guigan,
Lehrer
DEEP BREATHING TECHNIQUES
Individuals tend to breathe shallowly or even hold breath
when feeling anxious.
The key to deep breathing is to breathe deeply from the
abdomen, getting as much air as possible into your
lungs.
The importance of good posture cannot be overstated.
There are many ways to practice deep breathing.
Principles and Practice of Stress Management, Third Edition 2007
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime Chapter 12
GUIDED IMAGERY
Convenient and simple relaxation technique that can
help quickly and easily manage stress and reduce
tension.
When used as a relaxation technique, it involves
imagining a scene in which one feels at peace, free to
let go of all tension and anxiety. One can choose
whatever setting is most calming, whether a favorite
childhood spot, a therapist‟s chair, or a quiet place.
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
SELF-MASSAGE TECHNIQUES
THOUGHT STOPPING TECHNIQUES
Thought stopping requires consistent motivation.
Select a thought that one feels strongly committed to
extinguishing.
Imagine the Thought
Thought Interruption
Unaided Thought Interruption
Thought Substitution
Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New
Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by
Changing the Way You Think. Guilford Publications. New York, NY.
OTHER STRESS COPING STRATEGIES
THAT CAN BE INITIATED/SELF-TAUGHT
Breathing Retraining and Exercise
Whole-Body Breathing
Exercise Therapy
Methods Based on Eastern Meditative and
Therapeutic Disciplines
Mindfulness Meditation
Qigong Therapy
Yoga
Other Methods
Music Therapy
Eye Movement Desensitization and Reprocessing
Principles and Practice of Stress Management, Third Edition
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime 2007
OVERVIEW OF PSYCHIATRIC
STRESS MANAGEMENT METHODS
OVERVIEW OF PSYCHIATRIC STRESS
MANAGEMENT METHODS
BIOFEEDBACK
NEUROFEEDBACK
AUTOGENIC TRAINING METHOD
AUTOGENIC BIOFEEDBACK TRAINING
Principles and Practice of Stress Management, Third Edition
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime 2007
OVERVIEW OF PSYCHIATRIC STRESS
MANAGEMENT METHODS (contd.)
COGNITIVE METHODS
STRESS INOCULATION TRAINING
PHARMACOLOGICAL APPROACH TO STRESS
MANAGEMENT AND ANXIETY DISORDERS
Principles and Practice of Stress Management, Third Edition
edited by Paul M. Lehrer, Robert L. Woolfolk, Wesley E. Sime 207
CURRENT TRENDS IN STRESS
MANAGEMENT
CURRENT TRENDS IN STRESS
MANAGEMENT
There are an increasing number of studies that have monitored
the impact of Stress Management Interventions (SMls).
The UK perspective: A review of research on organisational stress management Interventions SABIR .GIGA et al. July
2003 ' australian Psychologist Volume 38 number 2 pp. 158-164
CURRENT TRENDS IN STRESS MANAGEMENT (contd.)
Jac J. L. van der Klink et al. The Benefits of Interventions for Work-Related Stressention types.
(Am J Public Health. 2001;91:270–276
CURRENT TRENDS IN STRESS
MANAGEMENT FOR MEDICAL
STUDENTS
CURRENT TRENDS IN STRESS
MANAGEMENT FOR MEDICAL STUDENTS Proposed model of causes and consequences of student distress
Liselotte N. DYRBYE Et Al. Medical Student Distress:
Causes, Consequences, And Proposed Solutions Mayo Clin Proc. 2005;80(12):1613-1622
CURRENT TRENDS IN STRESS MANAGEMENT
FOR MEDICAL STUDENTS (contd.)
Academic leaders have recognized the importance of developing stress-management programs for medical students.
Randomized, controlled trials or controlled, non-randomized trials reviewed show that:
Interventions that have been undertaken and found effective for stress management amongst medical students were:
Self-hypnosis
Meditation
Mindfulness-based stress-reduction
Feedback on various health habits
Educational discussion
Changes in the length and type of curriculum
Changes in the grading system
Shiralkar, M.T., Harris, T.B., Eddins-Folensbee, F.F. et al. Acad Psychiatry (2013) 37:
158. doi:10.1176/appi.ap.12010003
CURRENT TRENDS IN STRESS MANAGEMENT
FOR MEDICAL STUDENTS (contd.)
Outcomes of brief stress management intervention (required duration of less than 2 days)
Chapte r from the Book Social Scie nce s and Cultural Studie s - Is s ue s of Lang uag e , Public Opinion, Education and We lfare Downloade d
from: http://www.inte chope n.com/books /s ocial-s cie nce s -and-culturals tudie s -is s ue s -of-lang uag e -public-opinion-e ducation-and-we
lfare
.
CURRENT TRENDS IN STRESS MANAGEMENT
FOR MEDICAL STUDENTS (contd.)
Outcomes of short-duration stress management intervention (required duration of 2 days to 4 weeks)
Chapte r from the Book Social Scie nce s and Cultural Studie s - Is s ue s of Lang uag e , Public Opinion, Education and We lfare
Downloade d from: http://www.inte chope n.com/books /s ocial-s cie nce s -and-culturals tudie s -is s ue s -of-lang uag e -public-opinion-e
ducation-and-we lfare
Outcomes of medium-duration stress management intervention (required duration of more than 4
weeks and up to 8 weeks).
Chapte r from the Book Social Scie nce s and Cultural Studie s - Is s ue s of Lang uag e , Public Opinion, Education and We lfare Downloade d from: http://www.inte chope
n.com/books /s ocial-s cie nce s -and-culturals tudie s -is s ue s -of-lang uag e -public-opinion-e ducation-and-we lfare
CONCLUSION
There are resources available and approachable for stress
management interventions which require professional help
and expertise.
Department of Psychiatry, World College of Medical
Sciences and Research and Hospital provides:
Outpatient services
Inpatient ward facility
Weekly OPD services at Civil Hospital, Jhajjar
Psychiatric and Psychological Instruments for assessment
and intervention
Confidentiality
THANK YOU
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